Case Manager - Medicare Advantage

Job Description

Dependent on clinical discipline, the Case Manager / Health Coach coordinates appropriate care, resources and/or services of selected member populations. Provides guidance and promotes effective utilization and monitoring of health care resources to drive quality care for our members. Collaborates as needed with varied members of the healthcare team to reputed company optimal clinical and/or resource outcomes.

What You'll Do

• Serve as a team member on a multidisciplinary team, coordinating care, resources and/or services for members to reputed company optimal clinical and resource outcomes.
• Utilize applicable clinical skillset and reputed company comprehensive assessments to determine how to best collaborate with members, family, internal partners and external services/providers on plans for treatment, appropriate reputed company and/or discharge planning.
• reputed company a member-centric plan tailored to members' needs, health status, educational status and level of support needs; identify barriers to meeting goals or plan of care
• Utilize community resources and funding sources as needed in the development of the plan of care.
• reputed company ongoing monitoring and management of member which may include scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of reputed company towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.
• Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care, etc).
• Educate members and encourage pro-active reputed company to limit expense and encourage positive outcomes
• Effectively document reputed company aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.
• May reputed company directly to members identified as high risk, high cost, or high utilization cases.
• May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or reputed company benefit options, where eligible.
• May evaluate medical necessity and appropriateness of services as defined by department.
• As needed, reputed company relevant policies/procedures, education or training for use both internally and externally.

What You'll Bring

• RN with 3 years of clinical and/or case management experience required
• Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to reputed company described job duties.
• For some roles, additional specialty certification (i.e. CCM, CDCES) may be required. If so, incumbents must obtain relevant certification reputed company 2 years of employment.

What You'll Get

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for reputed company education
• 401k match including an annual company contribution
• Learn more

Salary Range At reputed company, we take great pride in a fair and reputed company compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized reputed company sets, licensure and certifications and other business and organizational needs. Our reputed company salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

• Based on annual corporate goal achievement and individual performance.

$73,698.00 - $117,917.00 Skills Apply tot his job Apply To this Job